Adjustment disorders

Date Updated: 10/25/2017

Overview

Adjustment disorders are stress-related conditions. You experience more stress than would normally be expected in response to a stressful or unexpected event, and the stress causes significant problems in your relationships, at work or at school.

Work problems, going away to school, an illness, death of a close family member or any number of life changes can cause stress. Most of the time, people adjust to such changes within a few months. But if you have an adjustment disorder, you continue to have emotional or behavioral reactions that can contribute to feeling anxious or depressed.

You don't have to tough it out on your own, though. Treatment can be brief and it's likely to help you regain your emotional footing.

Symptoms

Signs and symptoms depend on the type of adjustment disorder and can vary from person to person. You experience more stress than would normally be expected in response to a stressful event, and the stress causes significant problems in your life.

Adjustment disorders affect how you feel and think about yourself and the world and may also affect your actions or behavior. Some examples include:

Feeling sad, hopeless or not enjoying things you used to enjoy
Frequent crying
Worrying or feeling anxious, nervous, jittery or stressed out
Trouble sleeping
Lack of appetite
Difficulty concentrating
Feeling overwhelmed
Difficulty functioning in daily activities
Withdrawing from social supports
Avoiding important things such as going to work or paying bills
Suicidal thoughts or behavior

Symptoms of an adjustment disorder start within three months of a stressful event and last no longer than 6 months after the end of the stressful event. However, persistent or chronic adjustment disorders can continue for more than 6 months, especially if the stressor is ongoing, such as unemployment.

When to see a doctor

Usually stressors are temporary, and we learn to cope with them over time. Symptoms of adjustment disorder get better because the stress has eased. But sometimes the stressful event remains a part of your life. Or a new stressful situation comes up, and you face the same emotional struggles all over again.

Talk to your doctor if you continue to struggle or if you're having trouble getting through each day. You can get treatment to help you cope better with stressful events and feel better about life again.

If you have concerns about your child's adjustment or behavior, talk with your child's pediatrician.

Suicidal thoughts or behavior

If you have thoughts of hurting yourself or someone else, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor.

Causes

Adjustment disorders are caused by significant changes or stressors in your life. Genetics, your life experiences, and your temperament may increase your likelihood of developing an adjustment disorder.

Risk factors

Some things may make you more likely to have an adjustment disorder.

Stressful events

Stressful life events — both positive and negative — may put you at risk of developing an adjustment disorder. For example:

Divorce or marital problems
Relationship or interpersonal problems
Changes in situation, such as retirement, having a baby or going away to school
Adverse situations, such as losing a job, loss of a loved one or having financial issues
Problems in school or at work
Life-threatening experiences, such as physical assault, combat or natural disaster
Ongoing stressors, such as having a medical illness or living in a crime-ridden neighborhood

Your life experiences

Life experiences can impact how you cope with stress. For example, your risk of developing an adjustment disorder may be increased if you:

Experienced significant stress in childhood
Have other mental health problems
Have a number of difficult life circumstances happening at the same time

Complications

If adjustment disorders do not resolve, they can eventually lead to more serious mental health problems such as anxiety disorders, depression or substance abuse.

Prevention

There are no guaranteed ways to prevent adjustment disorders. But developing healthy coping skills and learning to be resilient may help you during times of high stress.

If you know that a stressful situation is coming up — such as a move or retirement — call on your inner strength, increase your healthy habits and rally your social supports in advance. Remind yourself that this is usually time-limited and that you can get through it. Also consider checking in with your doctor or mental health professional to review healthy ways to manage your stress.

Diagnosis

Diagnosis of adjustment disorders is based on identification of major life stressors, your symptoms and how they impact your ability to function. Your doctor will ask about your medical, mental health and social history. He or she may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

For diagnosis of adjustment disorders, the DSM-5 lists these criteria:

Having emotional or behavioral symptoms within three months of a specific stressor occurring in your life
Experiencing more stress than would normally be expected in response to a stressful life event and/or having stress that causes significant problems in your relationships, at work or at school
Symptoms are not the result of another mental health disorder or part of normal grieving

Types of adjustment disorders

The DSM-5 lists six different types of adjustment disorders. Although they're all related, each type has unique signs and symptoms. Adjustment disorders can be:

With depressed mood. Symptoms mainly include feeling sad, tearful and hopeless and experiencing a lack of pleasure in the things you used to enjoy.
With anxiety. Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Children who have an adjustment disorder with anxiety may strongly fear being separated from their parents and loved ones.
With mixed anxiety and depressed mood. Symptoms include a combination of depression and anxiety.
With disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting or reckless driving. Youths may skip school or vandalize property.
With mixed disturbance of emotions and conduct. Symptoms include a mix of depression and anxiety as well as behavioral problems.
Unspecified. Symptoms don't fit the other types of adjustment disorders, but often include physical problems, problems with family or friends, or work or school problems.

Length of symptoms

How long you have signs and symptoms of an adjustment disorder also can vary. Adjustment disorders can be:

Acute. Signs and symptoms last six months or less. They should ease once the stressor is removed.
Persistent (chronic). Signs and symptoms last more than six months. They continue to bother you and disrupt your life.

Treatment

Many people with adjustment disorders find treatment helpful, and they often need only brief treatment. Others, including those with persistent adjustment disorders or ongoing stressors, may benefit from longer treatment. Treatments for adjustment disorders include psychotherapy, medications or both.

Psychotherapy

Psychotherapy, also called talk therapy, is the main treatment for adjustment disorders. This can be provided as individual, group or family therapy. Therapy can:

Provide emotional support
Help you get back to your normal routine
Help you learn why the stressful event affected you so much
Help you learn stress-management and coping skills to deal with stressful events

Medications

Medications such as antidepressants and anti-anxiety drugs may be added to help with symptoms of depression and anxiety.

As with therapy, you may need medications only for a few months, but don't stop taking any medication without talking with your doctor first. If stopped suddenly, some medications, such as certain antidepressants, may cause withdrawal-like symptoms.

Lifestyle and home remedies

Here are some steps you can take to care for your emotional well-being.

Tips to improve resilience

Resilience is the ability to adapt well to stress, adversity, trauma or tragedy — basically, the ability to bounce back after experiencing a difficult event. Building resilience may vary from person to person, but consider these strategies:

Stay connected with healthy social supports, such as positive friends and loved ones.
Do something that gives you a sense of accomplishment, enjoyment and purpose every day.
Live a healthy lifestyle that includes good sleep, a healthy diet and regular physical activity.
Learn from past experiences about how you can improve your coping skills.
Remain hopeful about the future and strive for a positive attitude.
Recognize and develop your personal strengths.
Face your fears and accept challenges.
Make a plan to address problems when they occur, rather than avoid them.

Find support

It may help you to talk things over with caring family and friends, receive support from a faith community, or find a support group geared toward your situation.

Talk to your child about stressful events

If your child is having difficulty adjusting, try gently encouraging your child to talk about what he or she is going through. Many parents assume that talking about a difficult change, such as divorce, will make a child feel worse. But your child needs the opportunity to express feelings of grief and to hear your reassurance that you'll remain a constant source of love and support.

Preparing for an appointment

Whether you start by seeing your primary care doctor or a mental health professional for evaluation and treatment, here's some guidance to help you prepare for your appointment, and what to expect from your doctor.

If possible, you may want to take notes during the visit or bring along a family member or friend to help you remember information.

What you can do

To prepare for your appointment, make a list of:

Any symptoms you've been experiencing, and for how long.
Key personal information, including any major stresses or recent life changes, both positive and negative.
Medical information, including other physical or mental health conditions with which you've been diagnosed. Include any medications, vitamins, herbs or other supplements you're taking, and the dosages.
Questions to ask your doctor to make the most of your time together.

Some questions to ask your doctor may include:

What do you think is causing my symptoms?
Are there any other possible causes?
Is my condition likely temporary or long term?
Do you recommend treatment? If yes, with what approach?
How soon do you expect my symptoms to improve?
Should I see a mental health specialist?
Do you recommend any temporary changes at home, work or school to help me recover?
Are there any brochures or other printed material that I can have?
What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

What are your symptoms?
When did you or your loved ones first notice your symptoms?
What major changes have recently occurred in your life, both positive and negative?
How have you tried to cope with these changes?
How often do you feel sad or depressed?
Do you have thoughts of suicide?
How often do you feel anxious or worried?
Are you having trouble sleeping?
Do you have difficulty finishing tasks at home, work or school that previously felt manageable to you?
Are you avoiding social or family events?
Have you been having any problems at school or work?
Have you made any impulsive decisions or engaged in reckless behavior that doesn't seem like you?
Do you drink alcohol or use recreational drugs? How often?
Have you been treated for other mental health disorders in the past? If yes, what type of therapy was most helpful?